Journal of hepato-biliary-pancreatic sciences
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J Hepatobiliary Pancreat Sci · Sep 2010
Review Meta AnalysisIntraperitoneal use of local anesthetic in laparoscopic cholecystectomy: systematic review and metaanalysis of randomized controlled trials.
With the advent of minimally invasive gallbladder surgery, and now with natural orifice techniques emerging, visceral nociception has been neglected as a cause of postoperative pain. A systematic review and metaanalysis was carried out to investigate the use of intraperitoneal local anesthetic (IPLA) in order to assess its role in laparoscopic cholecystectomy (LC). The aim of this systematic review was to appraise the clinical effects of this modality. ⋯ There is evidence in favor of IPLA in LC. Further trials of this modality in LC are not needed as these are unlikely to reduce clinical heterogeneity. IPLA should be trialled as future minimally invasive surgical techniques approach.
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J Hepatobiliary Pancreat Sci · Sep 2010
Comparative StudyIntraoperative fluorescent imaging using indocyanine green for liver mapping and cholangiography.
Preoperative imaging is widely used and extremely helpful in hepatobiliary surgery. However, transfer of preoperative data to a intraoperative situation is very difficult. Surgeons need intraoperative anatomical information using imaging data for safe and precise operation in the field of hepatobiliary surgery. We have developed a new system for mapping liver segments and cholangiograms using intraoperative indocyanine green (ICG) fluorescence under infrared light observation. ⋯ Application of this technique allows intraoperative identification of anatomical landmark in hepatobiliary surgery.
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J Hepatobiliary Pancreat Sci · Jul 2010
Comparative StudySurgical treatment of hilar cholangiocarcinoma in the new era: the Asan experience.
Both curative resection and minimized in-hospital mortality offer the only chance of long-term survival in patients with hilar cholangiocarcinoma. The reported resectability rates for hilar cholangiocarcinoma have increased by virtue of combined major hepatectomy, but this procedure is technically demanding and still associated with a significant morbidity and mortality that must be carefully balanced against the chances of long-term survival. ⋯ Preoperative biliary decompression and portal vein embolization enabled us to reduce in-hospital deaths associated with extended hepatectomy for hilar cholangiocarcinoma. Major hemihepatectomy offers an increased survival because of the higher possibility of curative resection than bile duct resection alone and parenchyma-preserving hepatectomy, but it still carries a certain mortality. Less extensive procedures can be conducted safely and are beneficial for aged patients in poor condition with a less advanced tumor stage if tumor-free resectional margins are obtained.
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J Hepatobiliary Pancreat Sci · Jul 2010
Comparative StudyHilar cholangiocarcinoma: the Memorial Sloan-Kettering Cancer Center experience.
Hilar cholangiocarcinoma (HCCA) is a rare cancer with a low resectability rate, frequent recurrence after resection and an overall poor outcome. It is widely accepted that en bloc partial hepatectomy is a necessary part of the surgical therapy, but controversy surrounds other areas, including extent of lymphadenectomy and preoperative use of biliary drainage of the future liver remnant (FLR). This study analyzes the authors' experience with HCCA, emphasizing outcome after resection in a more recent cohort. ⋯ R0 resection including hepatectomy with negative lymph nodes is feasible in the majority of patients with resectable HCCA. This strategy is associated with a prolonged disease-specific survival.
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J Hepatobiliary Pancreat Sci · May 2010
Risk factors for postoperative pancreatic fistula after pancreaticoduodenectomy: the significance of the ratio of the main pancreatic duct to the pancreas body as a predictor of leakage.
Postoperative pancreatic fistula (POPF) is a severe and frequent complication after pancreaticoduodenectomy (PD). The aim of this study was to identify an independent predictor of POPF and to assess the efficacy of preoperative multidetector row computed tomography (MDCT) images as an indicator for POPF. ⋯ The MPD index obtained from preoperative MDCT can be a reliable predictor of POPF after PD.